Form CG-950A Application for Special Permit

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard
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OMB NO. 1625-0032
Exp.Date: 03/31/2015

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB number.
The Coast Guard estimates that the average burden for this report is 10 minutes. You may submit any comments concerning the accuracy of this
burden estimate or any suggestion for reducing the burden to: Commandant (CG-CVC), U.S. Coast Guard, 2100 2nd Street SW Stop 7581,
Washington, DC 20593-7581 or Office of Management and Budget, Paperwork Reduction Project (1625-0032), Washington, DC 20503.
INSTRUCTIONS
1. This form should be completed to the fullest extent possible. Incomplete information will delay processing of this application and may be cause
for denial of special permit issuance.
2. Upon completion, this form should be mailed or delivered to the Coast Guard's senior operational commander for the marine Event of National
Significance. For foreign (non- U.S.) -flag vessels, a copy of the official safety certificates issued by the vessel's flag authority should be included
with this application. Any supplemental authorizations issued by the flag authority for the event should also be included.
3. Questions concerning this form, including address information for mailing, can be directed to your event sponsor or to Commandant (CG-CVC).

Date of Request:
Marine Event of National Significance (title):
Date/Period of Vessel Participation in Event:
U.S. Ports to be visited:
(date/location)

Vessel Name:

Flag of Registry:

Official (IMO) Number:

Gross Tonnage:

Owner Information:

Operator Information:

Name:
Address:

Phone:
Email:
1

Public Vessel? (Y/N):

3

Certified by Flag Authority? (Y/N):

4

Certificate of Financial Responsibility (COFR)? (Y/N):

2

Engaged in Commercial Service? (Y/N):
Valid Load Line Certificate? (Y/N):

5

Moored Attraction Vessel? (Y/N):

Maximum number of Passengers and/or Sail Trainees to be carried during the event:
Passengers:
Sail Trainees:
CG-950A (03/12)

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APPLICATION FOR SPECIAL PERMIT
Vessel Name:

Primary Lifesaving Equipment (indicate number & capacity for each):
Lifeboats
Liferafts
Buoyant Apparatus
Life Preservers (number adult/children)

Firefighting Systems/Equipment:
Fixed extinguishing systems (space protected/type)
e.g. engine room/CO2
Portable extinguishers (number/type)
e.g. 2 / 20lb dry chem.

The undersigned herby certifies that sufficient safety arrangements will be made as necessary for the safety of
the lives of passengers on board in case of accident.

Master, Owner, or Agent

FOOTNOTES:
1. "Public Vessel" means a vessel that is owned, or demise chartered, and operated by the United States Government or a Government of a
foreign country and is not engaged in commercial service.
2. "Commercial Service" includes any type of trade or business involving the transportation of goods or individuals, except service performed by
a combatant vessel.
3. The Coast Guard will request detailed safety information for vessels lacking Flag certification in the form of either IMO certificates (Passenger
Ship Safety or Special Purpose Ship Code certificates) or other official designation by the Flag authority.
4. A Certificate of Financial Responsibility (COFR) is required for all self-propelled (motor or sail) vessels over 300 gross tons, with the exception
of public vessels.
5. "Moored Attraction Vessels" means a vessel that takes on passengers while moored and charges for admission. Such vessels are subject to
inspection as passenger vessels; Coast Guard Moored Attraction Vessel policy will apply.
CG-950A (03/12)

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